Efort Open Reviews最新文献

Purpose: This scoping review examines the epidemiology and incidence of complications associated with incorrect screw length in orthopaedic trauma surgeries, aiming to underscore its impact on clinical outcomes and healthcare costs.

Methods: Guided by Arksey and O'Malley's framework and PRISMA guidelines, a thorough search was conducted across PubMed, Web of Science, Cochrane, and Google Scholar up to April 2024. Studies included must be human-based orthopaedic procedures involving screw length, published in peer-reviewed journals with full text available, and report complications from incorrect screw length; studies excluded were systematic reviews/meta-analyses. Paper characteristics and data on incident rates of complications due to screw protrusion were extracted and presented in a supplementary table using Microsoft Excel.

Results: Of 2,285 studies identified, 31 met the inclusion criteria. Incorrect screw length led to severe complications, including neurovascular damage (7 studies), avascular necrosis (4 studies), delayed union or pseudoarthrosis (9), tendinitis/tendon rupture (12 studies), and pain (10 studies). Notably, improperly sized screws increased neurovascular and avascular necrosis complications, especially in weight-bearing joints. In addition, incorrect screw length was linked to higher hardware removal rates, contributing to increased healthcare costs. Limitations include the inability of some studies to definitively attribute complications to screw protrusion and the exclusion of cases involving joint collapse or solely mechanical complications.

Conclusion: This review underscores the importance of precise screw length selection to prevent complications and improve surgical outcomes. It calls for further research on the medico-legal and economic impacts of screw length errors and the need for better surgical practices.

Purpose: Various conservative and surgical treatments was clinically applied in rotator cuff calcific tendinitis (RCCT), the evaluation of distinction among all available intervention is still lacking. This study aims to systematically compare the efficacy and safety of these interventions and provide guidance for RCCT treatment.

Methods: The study utilized four electronic databases for literature retrieval and is registered in PROSPERO. Network meta-analyses (NMA) were conducted for continuous outcomes such as functional improvement and pain relief. For the outcome of calcification deposit resolution, due to discrepancies in statistical methods and insufficient data for pooling, a systematic review was conducted. The Cochrane Risk of Bias 2 tool was used to assess the risk of bias.

Results: A total of 33 randomized-controlled trials (RCTs) covering 26 treatment methods were included. In nonsurgical treatments, comprehensive physical therapy (PT) methods (ranked 1st in Surface Under the Cumulative Ranking (SUCRA)) showed the best performance in terms of functional improvement, followed by high-energy extracorporeal shock wave therapy (ESWT-H) + PT, which ranked 2nd. For pain relief, radial shock wave therapy (RSWT) + PT (ranked 1st) was most effective. In surgical treatments, arthroscopic bursectomy debridement of rotator cuff (ABD) + arthroscopic subacromial decompression (ASD) showed similar effects to ABD alone for functional improvement (SMD: -0.01, 95% CI: -0.54 to 0.57) and pain relief (SMD: -0.02, 95% CI: -0.51 to 0.43), with no significant differences observed. For calcification resolution, ultrasound-guided needling (UGN) + subacromial corticosteroid injection (SAI) demonstrated promising therapeutic potential.

Conclusion: Comprehensive PT demonstrates superior efficacy in improving functional outcomes, while RSWT + PT significantly alleviates pain. In terms of surgical interventions, ABD alone demonstrated similar clinical effects to ABD + ASD in both functional improvement and pain relief. However, there is currently no direct data to compare the effectiveness of operative versus nonoperative treatments for RCCT.

Trial registration: PROSPERO CRD42023476423.

Radiography is of importance in the diagnosis of atlantoaxial dislocation (AAD), and it is the basic imaging technique. However, it should not be the sole diagnostic modality, especially in complex or unclear cases. Conventional X-ray includes an open-mouth odontoid view and a cross-table lateral view, and careful study of radiological findings is crucial to give an early diagnosis of AAD. Lateral flexion-extension dynamic views are only used as an additional supplement in some special cases. Although X-ray images are enough to diagnose AAD in most cases, some patients suspected with AAD should be evaluated with the readily available and quick CT scan. If patients with AAD have symptoms of spinal cord and medullary compression, apart from conventional radiographs, a combination of high-quality CT and MRI of cervical spine are necessary for the diagnosis and choice of treatment. For patients with AAD, both the thin slice CT scanning with coronal, sagittal and three-dimensional reconstruction images and MRI of cervical spine are fundamental to surgical planning. Clinical classifications of AAD associated with imaging are useful in determining treatment strategies. The present study reviews publications on imaging and clinical classification of AAD to aid the clinician in the evaluation and management of these dislocations.

Occurring in 0.5-3% of cases, periprosthetic humerus fractures pose a challenge, necessitating effective management strategies. A comprehensive review was conducted using PubMed. Used terms included 'Periprosthetic humerus fractures; complications; periprosthetic fractures shoulder arthroplasty; periprosthetic humeral fracture treatment; nerve palsy humeral revision arthroplasty; infections after shoulder arthroplasty; postoperative complications AND open reduction AND humeral fractures; allograft AND long humeral stem'. Studies were excluded if they did not meet the actual topic, included more than primary shoulder arthroplasty and/or were in non-English or non-German language. Thirty-eight papers with evidence levels ranging from two to three were selected for this review. Various classification systems have been implemented; their validation though was based on studies with only a limited number of patients. Risk factors include osteopenia/osteoporosis, rheumatoid arthritis, age, age-related lifestyle and gender. Treatment options range from conservative approaches to plate osteosynthesis or revision to a longer stem. Nevertheless, there is a lack of biomechanic studies and randomized-controlled clinical studies; hence, the evidence is low. Complications in revision arthroplasty encompass infections, nonunions, and nerve palsies, highlighting the importance of individualized treatment planning. The management of periprosthetic humeral fractures requires careful consideration of risk factors and tailored treatment plans. Existing literature relies on small case series and expert opinions, highlighting the need for further research to establish optimal treatment strategies for these challenging fractures.

Purpose: Our study aims to compare different perioperative treatments to reduce C. acnes, the most common causative agent of surgical site infections following shoulder surgery.

Methods: A systematic search was performed in MEDLINE (PubMed), Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and the Web of Science for studies published up to October 20, 2022. We included randomized-controlled trails investigating the efficacy of different dermal preparation in reducing the C. acnes colonising the skin surface. The studies examined positive bacterial cultures before and after skin treatment. The included trials were able to compare seven different skin treatment methods. We performed a frequentist network meta-analysis and calculated pooled risk ratios (RRs) with 95% confidence interval (CI).

Results: Our study could include comparisons of 946 different patients. The use of 5% benzoyl peroxide (BPO) and its combination with the antibiotic clindamycin was found to be the most effective in reducing C. acnes colonization on the skin (BPO 5% RR = 0.25, CI: 0.08-0.72, BPO with clindamycin RR = 0.25, CI: 0.04-1.50). Based on the rank plot, 5% BPO (P score: 0.808) was the most effective treatment, followed by BPO 5% with clindamycin (P score: 0.749). We could not perform a network meta-analysis regarding the efficacy of different dermal preparation in reducing C. acnes colonization on the dermis and in the joint.

Conclusion: Cutibacterium colonization of the skin flora can be effectively reduced on the skin surface by the use of 5% BPO.

Charcot neuroarthropathy is the most severe complication of the diabetic foot. Its diagnosis is difficult and often overlooked, delaying management, with sometimes disastrous consequences. Its incidence is increasing due to the rapid global rise in the number of people with diabetes. Its pathophysiology remains unclear, although the activation of the RANK/RANK-L system appears to be involved, triggered either by neurotraumatic or neurovascular mechanisms, leading to the differentiation of monocytes into osteoclasts. Diagnosis relies on clinical and radiological arguments, particularly MRI. There are different types of Charcot foot depending on the evolution, according to Eichenholtz's classification and based on location according to Sanders and Brodsky's classifications. Treatment involves a multidisciplinary approach with diabetes management and addressing other general complications. Medical treatment is indicated as the first line, with offloading and immobilisation using a 'total contact cast'. In case of failure of this method, or if there is immediate deformity, surgical intervention is indicated, and techniques are evolving rapidly. Depending on the deformity, minimally invasive or arthroscopic procedures may be performed. In cases of significant deformity, foot reconstruction may be proposed, using the so-called 'super construct' technique if necessary. Infection will be treated concurrently or initially, depending on severity. Many complications are reported, but increasingly early and aggressive surgery improves patients' quality of life and reduces amputation rates.

Shoulder arthroplasty is increasingly utilised among patients under 55 years of age due to rising incidences of traumatic injuries, inflammatory arthritis, avascular necrosis, degenerative joint diseases and heightened participation in demanding sports and occupational activities. Anatomic shoulder arthroplasty (ASA) remains the preferred surgical option for younger patients with intact rotator cuffs and minimal glenoid deformities, preserving natural biomechanics, strength and range of motion, and demonstrating high long-term implant survival rates at 10-15 years. Despite favourable outcomes, ASA carries potential long-term risks including implant wear, prosthetic loosening, glenoid erosion and progressive rotator cuff degeneration, particularly relevant for physically active younger patients. Reverse shoulder arthroplasty (RSA) offers a valuable alternative in complex clinical scenarios characterised by irreparable rotator cuff tears, extensive glenoid bone loss, severe anatomical disruption or previous surgical failures. RSA can be used as an alternative to ASR for primary osteoarthritis and an intact rotator cuff, with excellent clinical outcomes and survivorship in patients over 60. RSA is also being used successfully in patients under the age of 55 with excellent short-term results. There remain concerns regarding the longevity and reliability of RSA in younger, highly active individuals. ASA can be revised to RSA with good clinical outcomes, while failure of RSA is extremely challenging to address. If we accept that ASA will fail with time, then the primary ASA should allow for ease of revision to an RSA. Recent advances in modular prosthetic designs facilitate simpler revisions from ASA to RSA.

Orthobiologics (OBs) have seen a constant increase in the number of available therapies and their clinical applications. Existing therapies can be categorized into blood-based (e.g., platelet-rich plasma (PRP)) and tissue/cell-based (e.g. mesenchymal stromal cells) approaches. While the popularity of OBs continues to grow, their diverse natures create unique challenges for the establishment of evidence-based guidelines. PRP has been reported by meta-analyses to increase patient-reported outcomes for conditions such as knee osteoarthritis (KOA), lateral epicondylitis and plantar fasciitis. However, the randomized controlled trials (RCTs) included often exhibit a high risk of bias due to the heterogeneity in the PRP preparation protocols and accompanying measures as well as inconsistent trial quality. The development pipeline of cell/tissue-based therapies is typically longer and more cost-intensive than that of blood-based therapies. Nevertheless, several products have demonstrated clinical safety. While some RCTs and meta-analyses on the outcome of cell/tissue-based therapies exist, their number is considerably lower than that of blood-based therapies and they focus mainly on KOA, with limited evidence on other orthopedic indications. Orthopedic societies such as ESSKA and AAOS have taken on the challenge of developing guidelines for OBs by combining high-level synthesized evidence with expert consensus. Patient stratification strategies represent a promising key to unlocking the full potential of OBs and are currently being investigated in ongoing studies. Further efforts to establish guidelines for the use of OBs should focus on developing frameworks for clinical trials and their reporting, alongside standardized protocols for the preparation, application and accompanying measures of OB therapies.